Gendered titles, barber surgeons and all that

The Royal Australasian College of Surgeons (RACS), in providing a background document supporting the removal of gendered titles, noted that surgery is the only profession that continues to use gendered titles in Australia and Aotearoa New Zealand. The document’s supporting references included an article from the British Medical Journal of December 23, 2000, entitled, Why are [male] surgeons still addressed as Mr? The author, a medical historian, wrote: ‘to understand how the tradition arose it is necessary to go back to the beginning of the 18th century’. The RACS background document noted that the use of the term ‘Mister’ for surgeons, dates to the 16th century when ‘barber surgeons’ performed operations at the direction of physicians. Such statements warrant both clarification and closer scrutiny. The barber surgeon was one of the most common European medical practitioners of the Middle Ages and as Europe emerged from the Dark Ages, surgery was at an elementary level. Barbers originally aided monks, who by the early 14th century were the traditional practitioners of medicine and surgery. The barber’s assistance was necessary, as following the Council of Tours in 1162, monks were forbidden to let blood.

Religious and sanitary monastic regulations required that monks maintained a tonsure—the traditional baldness on top of the head of Catholic monks—assuring a steady need for barbers. In addition to hair cutting and shaving, barbers performed simple surgical procedures including the lancing of abscesses, cupping, bloodletting, and the extraction of teeth. The existence of a Barbers’ Company was first evident in 1308. However, it was not until the Royal Charter of 1462 that the Worshipful Company of Barbers was finally incorporated. The barbers being granted armorial bearings by the Clarenceux King of Arms in September 1451, described as, ‘sabull a cheveron bytwene iii flemys of silver’. A flem or fleam, is a form of lancet, representing the bloodletting activities of the early barber.

In 1368 the surgeons had been allowed to form their own unincorporated Fellowship or Guild. They were granted a cognisance, or badge, by Henry VII, customarily flanked by the patron saints of surgeons, St Cosmos and St Damian. In heraldic parlance, the cognisance described as, ‘a spatter thereon a rose gules, crowned golde’. The spatter, which is visible beneath the crowned red rose, is a spatula, symbol of the surgeon’s craft: in fact, it is most difficult to discern in the final armorial bearings of 1569. When Henry VIII enacted the dissolution of monasteries in England between 1536 and 1539, many monks with a knowledge of elementary medicine and minor surgery, found themselves homeless, among the general population, and they undertook medical or surgical work to survive.

Their exodus was perhaps not without influence in leading to Henry VIII’s decision to unite the Barbers Company and the Fellowship of Surgeons by an Act of Parliament in 1540, thereby forming the Company of Barber-Surgeons, and thus regulating those services provided. Thomas Vicary, surgeon to Henry VIII, also played a pivotal role in the establishment of the new company, concerned as he was about the appropriate regulation of surgeons practising in the City of London. That memorable union is forever commemorated by the magnificent painting of Hans Holbein, detailing the monarch presenting Thomas Vicary, accompanied by surgeons and barbers, with their Charter. The original painting currently hangs in the Barber-Surgeons’ Hall in Monkwell Square, City of London: a cartoon is in the collection of the Royal College of Surgeons of England. The timing of this union was fortuitous as the works of Hippocrates and Galen were soon to become available to western European readers, and textbooks in English were to be written within a few

decades: anatomy was about to be revived by the publication in 1543 of the De Humani Corporis Fabrica of Vesalius. The Act of 1540 also allowed the bodies of four executed criminals to be an anatomised annually at public demonstrations. The teaching of anatomy became an important function of the Company: an anatomy theatre was designed for the Barber-Surgeons by Inigo Jones in 1636. To become a member of the Company, apprentice training would occupy seven years within the household of an experienced barber-surgeon; apprentices would assist in surgical care and gain hands-on experience in such tasks as setting bones and suturing wounds. As surgical training was by apprenticeship— and not academically—the Member title used was, Mister. Until the end of the 17th century the only general hospitals in London were St Bartholomew’s and St Thomas’. However, in the 18th century the Westminster, St George’s, Guy’s, Middlesex and London hospitals were built, and surgeons increased in number and importance. The Barber-Surgeons’ Company of London had controlled surgery in the metropolis for 200 years: and although initially the barbers outnumbered surgeons 20:1, gradually a greater part of the company’s income came from increasing numbers of surgeons, who began to desire independence. In early 1745, a Bill was introduced in Parliament to again separate the surgeons and the barbers of London into two separate and distinct corporations. The Bill soon became an Act to which the Royal signature was affixed on 2 May 1745, and an independent Company of Surgeons was thus formed. That company, in 1800, became the Royal College of Surgeons in London, and, subsequently in 1843, the Royal College of Surgeons of England, retaining the eponymous lectures and scholarships of the previously combined body, and also the gendered titles. One difference was immediately evident, the desire of the surgeons to sever their former connection with the City of London.

The Worshipful Company of Barbers came again into being following the dissolution of 1745; the Barbers retaining both the Barber-Surgeons’ Hall and the name of the hall, the silver, and much of the treasure, including Holbein’s portrait of Henry VIII. There has since been no modification of the Arms granted by Queen Elizabeth I in 1569, and the Company of Barbers, to this day, incorporates the original badge given to the surgeons in 1492. The company’s Latin motto is De Praescientia Dei, or from the foreknowledge of God. The Barber-Surgeons’ Hall was destroyed in the Great Fire of 1666, rebuilt, and destroyed again by German bombing in 1940. A new Barber-Surgeons’ Hall was opened in 1969 by Her Majesty, Queen Elizabeth, the Queen Mother. Today, the company has some 350 members, half of whom are medically qualified, and half of the latter being surgically qualified. Although the company has long lost its direct connection with the barbers’ trade, it flourishes and has important charitable aims, which include support of the teaching of anatomy at the Royal College of Surgeons, grants to medical and dental students, and support of schools in the city. Your author worked with John Chalstrey, an upper gastro-intestinal surgeon, at the Hackney Hospital in 1977. John later became Master of the Company of Barbers, and, in 1995, the first surgeon elected as Lord Mayor of the City of London, following which he was knighted. A tour of the Barber-Surgeons’ Hall is recommended for the London visitor. It is a magnificent building adjoining the old Roman Wall of the City, housing a truly impressive collection of royal charters and seals, records of the practice of barbery in early times, portraits and silver: tangible memorials of past surgical times.

Mr Peter F Burke FRCS FRACS DHMSA

Images (Clockwise from top-left): Henry VIII and the Barber-Surgeons 1540. Hans Holbein; Barbers’ arms.1451; Armorial bearings Worshipful Company of Barbers, 1569 to present time; Barber-Surgeons Hall. Cpy admitting a new member 1844:note Holbein portrait in the background; Surgeons’ cognisance 1492; Tonsured monk.